OA-143 Denials Explained: How to Identify, Appeal, and Prevent Them

Denial codes are a frustrating yet common issue for healthcare revenue cycle management (RCM) professionals. OA-143 denials, in particular, can delay payments and strain operational workflows. Understanding this denial code is critical to maintaining efficient cash flow and minimizing revenue leakage.

In this article, we’ll explore what OA-143 denials mean, their causes, their financial and operational impacts, and actionable steps to appeal and prevent them.

What Is a OA-143 Denial?

OA-143 is a denial code that indicates a portion of payment has been deferred and will be processed at a later date. The prefix “OA” stands for “Other Adjustment,” which signals that the denial is not attributed to patient responsibility (PR) or contractual obligation (CO). Instead, it points to administrative or payer-related adjustments.

The financial responsibility for OA-143 denials typically falls on the payer, as the deferred portion of the payment is expected to be processed eventually. However, providers must actively monitor and follow up to ensure payment is completed.

Comparison: OA-143 vs Similar Denial Codes

Denial Code	Prefix Meaning	Reason/Description	Who's Financially Responsible
OA-143	Other Adjustment	Portion of payment deferred.	Payer
OA-33	Other Adjustment	Claim denied as duplicate.	Provider
CO-97	Contractual Obligation	Payment adjusted per contract terms.	Provider

While OA-143 denotes deferred payment, OA-33 indicates duplicate claims, and CO-97 reflects adjustments due to contractual agreements. The key difference lies in the reason for denial and the responsible party, requiring specialized approaches for resolution.

Common Causes of OA-143 Denials

1. Incomplete or Delayed Payer Processing: Payments may be deferred due to payer system delays or administrative backlog.
2. Errors in Claim Submission: Incorrect or incomplete claim data can trigger deferred payments.
3. Unresolved Coordination of Benefits (COB): Payers may defer payments due to COB issues requiring clarification or documentation.
4. Pending Additional Documentation Requests: Payers may temporarily defer payment while awaiting supplementary records.
5. System Upgrades or Changes: Payer systems undergoing updates may delay processing claims temporarily.

Impact on Revenue Cycle Teams

OA-143 denials create significant financial and operational challenges for healthcare organizations:

Financial Impact:

• Revenue Loss: Deferred payments result in delayed cash inflows, potentially leading to revenue leakage.
• Extended Accounts Receivable (AR) Days: Increased AR days strain cash flow and financial planning.
• Write-Off Risk: Failing to follow up on deferred payments could lead to permanent revenue loss.
• Operational Costs: RCM teams must allocate additional resources to denial management, increasing overhead expenses.

Operational Impact:

• Resource Allocation: Staff time is diverted from other critical functions to focus on tracking and resolving denials.
• Interdepartmental Coordination: Billing, coding, and clinical teams must collaborate to address deferred claims effectively.
• Knowledge Requirements: RCM teams need expertise in payer policies and documentation standards to overcome OA-143 denials.
• Denial Tracking: Monitoring and analyzing denial patterns consumes valuable operational bandwidth.

To mitigate these impacts, healthcare organizations can leverage CombineHealth.ai’s Adam (AI Denial Manager) to streamline denial tracking and resolution, improving cash flow and reducing operational strain.

Steps To Appeal a OA-143 Denial

Step 1: Review the Denial Notice
Carefully assess the explanation of benefits (EOB) or remittance advice to understand the reason for deferment.

Step 2: Gather Documentation
Compile all relevant documents, including the original claim, supporting medical records, and payer communication.

Step 3: Verify Eligibility
Confirm that the patient was eligible for coverage at the time of service and all COB requirements were met.

Step 4: Prepare Appeal Letter
Draft a professional and concise appeal letter outlining the denial issue, supporting evidence, and a request for prompt payment processing.

Step 5: Submit Within Deadline
Ensure the appeal is submitted within the payer’s specified timeframe to avoid forfeiting payment.

Step 6: Track and Follow Up
Monitor appeal progress closely and maintain regular communication with the payer until the issue is resolved.

How To Prevent OA-143 Denials

Front-End Prevention

• Eligibility Verification: Conduct real-time eligibility checks before services are rendered.
• Clear COB Documentation: Resolve COB requirements upfront to avoid deferred payments.

Billing Best Practices

• Accurate Claim Submission: Double-check claims for completeness and accuracy before submission.
• Timely Response to Payer Requests: Submit any requested documentation promptly to prevent delays.

Technology Solutions

• Automated Claim Scrubbing: Use AI-driven claim scrubbing tools to identify potential issues before submission.
• Denial Management Platforms: Implement solutions like CombineHealth.ai’s Rachel (AI Appeals Manager) to streamline appeals and reduce processing time.

CombineHealth.ai’s advanced tools help healthcare organizations automate front-end processes and optimize denial management workflows, reducing the likelihood of OA-143 denials and improving overall revenue cycle performance.

FAQs

Q1: What does OA-143 mean in medical billing?
OA-143 indicates that a portion of payment has been deferred and will be processed at a later date.

Q2: Can OA-143 denials be appealed?
Yes, these denials can be appealed by providing supporting documentation and addressing the payer’s concerns.

Q3: How long do I have to appeal?
Deadlines vary by payer, but appeals should generally be submitted within 30-90 days of receiving the denial notice.

Q4: How can I prevent these denials?
Prevent OA-143 denials by conducting upfront eligibility checks, resolving COB issues, and leveraging automated claim scrubbing tools. See our complete guide on denial prevention